Associate Consultant

• BSc MSc nursing with NCLEX certification and active US RN license
• NCLEX Certified Nurse with 5 years of clinical experience

Key Responsibilities:

• Senior SME Skillset Training Data Management and reporting Quality Tools Descriptive Analysis New project Implementation
• Perform medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and Standard Operating procedures
• Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred
• Good understanding of US healthcare business
• Knowledge of utilization management processes preferred
• Ability to understand Milliman guidelines preferred
• Knowledge of managed care acute care emergency room cardiology radiology etc
• Understanding of ICD and CPT codes

Technical Requirements:

• Primary skills Operations Clinical Data Management
• Microsoft Word Excel Computer navigation typing skills effective communication skills both verbal and written

Additional Responsibilities:

• Ability to work with clients to identify business challenges and contribute to client deliverables by refining analyzing and structuring relevant data
• Awareness of latest technologies and trends
• Logical thinking and problem solving skills along with an ability to collaborate
• Ability to assess the current processes identify improvement areas and suggest the technology solutions
• One or two industry domain knowledge

Preferred Skills:

Operations->Clinical Data Management